Organization
ILLUMINATION COUNSELING & CONSULTATION SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERI NIDER LIMHP (SELF)
(308) 765-2401
Entity
Organization
Contact information
Practice address
3539 S 40TH ST, LINCOLN, NE 68506-5615
(308) 765-2401
Mailing address
3539 S 40TH ST, LINCOLN, NE 68506-5615
(308) 765-2401
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1905
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50504818202
—
NE
Enumeration date
02/26/2018
Last updated
02/26/2018
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